Project Summary/Abstract Billions of dollars have been spent on implementing health information technology (HIT), including elec- tronic health records (EHRs), based on the promise of improved patient safety and reduction of healthcare costs. However, safety concerns have arisen surrounding the technology and the resulting changes to workflow in care settings. Several examples of EHR-facilitated hazards have been identified, including inconsistent user interface design, corrupted files or databases after a software upgrade, sys- tem interface errors, and discrepancies in distributed systems that may facilitate medical errors, such as dosing errors, missed diagnoses, and delayed treatment. To fulfill the promise of HIT, these safety con- cerns must be overcome, but at present there is no accurate way to measure, and therefore monitor, the identified potential hazards related to EHRs. There is, therefore, a critical need to develop a comprehen- sive, validated set of measures of potential HIT safety hazards. Without this knowledge, healthcare sys- tems will be unable to adequately assess and improve the safety of implemented EHRs. Our long-term goal is to provide tools to improve the effective implementation and evaluation of EHRs across care set- tings. Based on needs identified in our prior research, our overall objective in this R21 proposal is to overcome current barriers by developing a pilot set of framework-based measures in key risk areas for EHR safety and to begin to implement the measures to allow future identification and reporting of best practices for EHR safety across healthcare organizations. The rationale for the proposed work, based on a conceptual framework developed by co-investigators and adapted by the National Quality Forum, is that with measures for risk areas across three domains ? safe HIT, using HIT safely, and monitoring safety ? healthcare settings and EHR vendors can overcome existing barriers in both detecting poten- tially unsafe system conditions and implementing interventions within the systems to prevent medical er- rors. We plan to accomplish our overall objective by pursuing the following two specific aims: 1) Define a pilot set of framework-based EHR safety measures, and 2) identify barriers and facilitators to implement- ing EHR safety measures. Overcoming the existing barriers to EHR safety measurement will allow us to continue working toward our long term goal by expanding the set of measures to include all risk areas and domains of the HIT safety framework, establishing benchmarks and identifying best practices associ- ated with EHR safety, and implementing multisite, real-time monitoring of measures to identify processes that are contributing to unsafe EHR use. Given the recent, rapid adoption of EHRs nationwide, the ability to systematically evaluate and improve the safety of EHRs has significant implications on developing methods for the delivery of safer and higher quality healthcare overall.